Fact vs Fear-Upper Cervical Manipulation

Many of us have been convinced in PT school that performing upper cervical manipulation techniques carry a much larger risk as compared to the rest of the spine even though there is no empirical evidence to support this notion. So why were we taught this?

With so much controversy and fear surrounding spinal manipulation therapy for treatment of upper cervical dysfunction its easy to see why most would accept this notion without evidence. This fear and apprehension has led most of us to just abandon treatment to the upper cervical spine altogether.

I believe submitting to this fear has led to a great disservice for our patients who struggle with neck pain and headaches that can best be resolved with focused treatment to their upper cervical spine, more specifically with performing thrust techniques to C0-2 regions. Herzog et al concluded, “cervical spinal manipulative therapy performed by trained clinicians does not appear to place undue strain on the vertebral artery, and thus does not seem to be a factor in vertebrobasilar injuries.”

If you are interested in learning more about the evidence behind performing these techniques and how to properly screen patients sign up for an "Open Packed Spinal Manipulation Course". 



Herzog W, Leonard TR, Symons B, Tang C, Wuest S. Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation. J Electromyogr Kinesiol. Oct 2012;22(5):740-746.